Journal of Refractive Surgery

Original Article Supplemental Data

Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment

Mengmeng Wang, MD; Christine Carole C. Corpuz, MD; Tukezban Huseynova, MD; Minoru Tomita, MD, PhD

Abstract

PURPOSE:

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment.

METHODS:

In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data.

RESULTS:

A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P < .05). Statistically significant correlations were present between preoperative pupil diameters and postoperative visual acuities (Rs > 0; P < .05). Patients with a larger pupil always have better postoperative visual acuities. Meanwhile, there was no statistically significant correlation between pupil decentration and visual acuities (P > .05).

CONCLUSIONS:

Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery.

[J Refract Surg. 2016;32(2):90–95.]

Abstract

PURPOSE:

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment.

METHODS:

In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data.

RESULTS:

A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P < .05). Statistically significant correlations were present between preoperative pupil diameters and postoperative visual acuities (Rs > 0; P < .05). Patients with a larger pupil always have better postoperative visual acuities. Meanwhile, there was no statistically significant correlation between pupil decentration and visual acuities (P > .05).

CONCLUSIONS:

Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery.

[J Refract Surg. 2016;32(2):90–95.]

A corneal astigmatism of 1.50 diopters (D) has been found in approximately 25% of eyes with cataract.1 Several options are currently available for reducing corneal astigmatism, such as limbal relaxing incisions, opposite clear corneal incisions, and laser refractive surgery. Comparing all of these options, multifocal toric intraocular lens (IOL) implantation would be the most concise and predictable strategy for the eyes with cataract that have significant corneal astigmatism because it can remove cataract, correct corneal astigmatism, and improve distance and near vision simultaneously.

The Lentis Mplus (Oculentis GmbH, Berlin, Germany) is a series of multifocal IOL models with a surface-embedded near segment.2–4 It is said that its surface-embedded near segment makes Mplus multifocal IOL models independent of pupil sizes greater than 2 mm5 and possesses good refractive predictability and high-quality optical performance.6,7 Recent studies also prove that the toric model of Lentis Mplus IOLs provides excellent visual and optical outcomes in eyes with cataract that have corneal astigmatism.8,9

Pupil parameters are important for modern cataract and refractive surgery.10,11 For the different multifocal IOL models, the pupil plays varying roles in the visual performance and optical quality.12,13 To the best of our knowledge, there has never been an article reporting the correlation between pupil parameters and the visual outcomes of Lentis Mplus toric IOLs. We conducted the current study to evaluate the relationship between pupil parameters and the visual outcomes of a new Lentis Mplus toric IOL model.

Patients and Methods

Patients

This prospective single-center study comprised patients with cataract who underwent cataract surgery with Lentis Mplus multifocal IOL implantation from July to October 2013 at the Shinagawa LASIK Center, Tokyo, Japan. The inclusion criteria were patients with incipient or moderate cataracts and a corneal astigmatism of at least 1.00 D. The exclusion criteria were patients with active ocular diseases (eg, age-related macular degeneration and diabetic retinopathy) and serious postoperative complications (eg, posterior capsular opacity and obvious capsule contraction) during the 3-month follow-up. All patients read and signed the informed consent forms, which explained the surgical procedure, possible risks, and patient rights. The study was performed with approval from the Institutional Review Board of Matsumoto Clinic, Tokyo, Japan.

Preoperative Examinations

Preoperative examinations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at a distance of 30 cm, corrected near visual acuity (CNVA) at a distance of 30 cm, uncorrected intermediate visual acuity (UIVA) at a distance of 70 cm, sphere, cylinder, manifest refraction spherical equivalent, intraocular pressure (Computerized Tonometer; Topcon Corporation, Tokyo, Japan), slit-lamp biomicroscopy, funduscopy, tomography (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany), and corneal endothelial cell count (Noncon Robo FA3609; Konan Medical, Inc., Hyogo, Japan). Both pupil diameter and pupil decentration were measured by the OPD-ScanII ARK-10000 (NIDEK Co., Gamagori, Aichi, Japan). The distance of the pupil decentration is the actual distance between the corneal apex and pupil center. IOLMaster (Carl Zeiss Meditec, Jena, Germany) and Online Oculentis Toric Intraocular Lens Calculator ( http://www.lentistoric.com/GB/Intro.aspx) were used for the biometry and power calculation of the multifocal toric IOLs.

Multifocal Toric IOLS

The Lentis Mplus toric LU-313 30TY is a new-generation one-piece multifocal toric IOL model with ultraviolet light filter. Like other Lentis Mplus IOL models,2,4,9,14 its anterior surface has a sector-shaped near-vision segment, which provides +3.00 D of near addition. The plate-haptic design provides this IOL model good stability4; the square-edge design and posterior 360° continuous barrier can reduce the posterior capsular opacity formation.15 Its spherical power varies from +0.00 to +36.00 D, and cylindrical power from +0.25 to +12.00 D.

Surgical Technique

Femtosecond laser-assisted phacoemulsification was performed on all eyes with cataract by the same surgeon (MT). The Catalys Precision Laser System (Optimedica Corp., Sunnyvale, CA) was used for the continuous curvilinear capsulorhexis and lens fragmentation of all cataracts. The incision was created on the temporal cornea. After the cut capsule was removed, the INFINITI Vision System (Alcon Laboratories, Inc., Fort Worth, TX) was used for the phacoemulsification. The foldable multifocal toric IOL was inserted and rotated into the intact capsular bag. According to the manufacturer's suggestion, the IOL was shifted to ensure that the near segment was located inferiorly. The viscoelastic material was completely removed by irrigation and aspiration. All incisions were left sutureless.

Postoperative Treatments

The following medications were given to all eyes postoperatively: 500 mg of oral levofloxacin (Cravit; Daiichi Sankyo, Tokyo, Japan) once a day for 3 days; 0.1% diclofenac sodium eye drops (Diclofenac Ophthalmic Solution 0.1%; Nitto Medic, Toyama, Japan), 0.1% dexamethasone metasulfobenzoate sodium (D•E•X; Nitto Medic), and 0.5% moxifloxacin hydrochloride (Vegamox; Alcon Laboratories, Inc.) five times a day for 1 week. After 1 week, the diclofenac use was reduced to four times a day for 1 month, and the latter two medications were changed to topical 0.1% fluorometholone ophthalmic suspension (Fluorometholone Ophthalmic Suspension 0.1%T; Nitto Medic) and 0.3% ofloxin ophthalmic solution (Ofloxin Ophthalmic Solution 0.3%; Nitto Medic) prescribed four times a day for up to 1 month, after which their use was discontinued.

Postoperative Examinations

At 3 months postoperative, UDVA, CDVA, UNVA at a distance of 30 cm, CNVA at a distance of 30 cm, and UIVA at a distance of 70 cm were measured. Other postoperative examinations, such as refraction, intraocular pressure, slit-lamp biomicroscopy, and funduscopy examinations, were routinely performed during the follow-up.

Statistical Analysis

Statistical analysis was performed with JMP 9 statistical package (SAS Institute, Inc., Cary, NC) software. Descriptive statistical results were presented as mean ± standard deviation. A paired t test was used to check the changes in the visual parameters at 3 months postoperatively compared with the preoperative values. The associations between the preoperative pupil parameters and postoperative visual outcomes were statistically examined using the Spearman's rank-order correlation coefficient (Rs) for nonparametric data. A P value of less than .05 was considered statistically significant.

Results

A total of 27 eyes of 16 patients were enrolled into the current study. Patient demographics are summarized in Table 1. The preoperative and postoperative conditions in visual and refractive parameters are shown in Table 2. Improvement in visual and refractive parameters was statistically significant after the implantation of the Lentis Mplus toric LU-313 30TY IOL (P < .05). There were no intraoperative (eg, radial nick or capsular tear) and postoperative (eg, posterior capsular opacity or obvious capsule contraction) complications in any eye with this IOL model during our study.

Demographic Data of the Study Population

Table 1:

Demographic Data of the Study Population

Visual and Refractive Outcomes Before and After Multifocal Toric IOL Implantation

Table 2:

Visual and Refractive Outcomes Before and After Multifocal Toric IOL Implantation

The associations between preoperative pupil diameters and postoperative visual conditions are shown in Table A (available in the online version of this article) and Figure 1. The photopic pupil diameters showed moderate but statistically significant correlations with UDVA, UNVA, and CNVA, respectively (Rs > 0; P < .05). A moderate but statistically significant correlation was also found between the mesopic pupil diameters and the 3-month postoperative CNVA (Rs = 0.4407; P = .0242).

Correlation Between Preoperative Pupil Diameters and 3-Month Postoperative Visual Outcomes

Table A:

Correlation Between Preoperative Pupil Diameters and 3-Month Postoperative Visual Outcomes

Scatterplots of the associations between the preoperative pupil diameters and 3-month postoperative visual acuities. (A) The association between the photopic pupil diameter and uncorrected distance visual acuity (UDVA). (B) The association between the photopic pupil diameter and uncorrected near visual acuity (UNVA). (C) The association between the photopic pupil diameter and corrected near visual acuity (CNVA). (D) The association between the mesopic pupil diameter and corrected near visual acuity (CNVA). Rs = Spearman's rank-order correlation coefficient

Figure 1.

Scatterplots of the associations between the preoperative pupil diameters and 3-month postoperative visual acuities. (A) The association between the photopic pupil diameter and uncorrected distance visual acuity (UDVA). (B) The association between the photopic pupil diameter and uncorrected near visual acuity (UNVA). (C) The association between the photopic pupil diameter and corrected near visual acuity (CNVA). (D) The association between the mesopic pupil diameter and corrected near visual acuity (CNVA). Rs = Spearman's rank-order correlation coefficient

The distributions of all preoperative pupil centers are shown in Figure A (available in the online version of this article). Associations between pupil decentrations and visual conditions are shown in Table B (available in the online version of this article). A moderate but statistically significant correlation was present between the mesopic pupil decentration and the 3-month postoperative CNVA (Rs = 0.4512, P = .0207; Figure 2. Associations between the superior (0° to 180°) pupil decentrations and visual conditions are shown in Table C (available in the online version of this article); associations between the inferior (180° to 360°) pupil decentrations and visual conditions are shown in Table D (available in the online version of this article). No statistically significant correlation was found between the superior or inferior pupil decentration and the visual parameters (P > .05).

The distribution of all preoperative pupil centers. The left figure shows the photopic pupil centers; the right figure shows the mesopic pupil centers.

Figure A.

The distribution of all preoperative pupil centers. The left figure shows the photopic pupil centers; the right figure shows the mesopic pupil centers.

Correlation Between Preoperative Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Table B:

Correlation Between Preoperative Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Scatterplot of the association between the preoperative pupil decentration under the mesopic condition and 3-month postoperative corrected near visual acuity (CNVA).

Figure 2.

Scatterplot of the association between the preoperative pupil decentration under the mesopic condition and 3-month postoperative corrected near visual acuity (CNVA).

Correlation Between Superior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Table C:

Correlation Between Superior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Correlation Between Inferior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Table D:

Correlation Between Inferior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Discussion

Generally speaking, refractive multifocal IOL models are dependent on the pupil size because of their concentric zones with varying refractive powers.16 When the incoming light rays pass through these IOLs, they are divided by the different refractive zones and concentrated on two or more focal points.17 Lentis Mplus IOL models belong to a type of zonal refractive aspheric multifocal IOLs, which are designed to comprise two optic zones, one for distance vision and the other for near vision.5 The distribution of distance and near refractive zones in Lentis Mplus IOL models is not concentric, but rather a rotational asymmetry.3,18 This optic design could allow more light to focus better on the distance, avoid the light scatter, provide better contrast sensitivity, and yield less halo and glare.2 According to a previous study,19 a non-toric, C-haptic model of the Lentis Mplus IOL exhibited pupillary independence. It was said that the distance and near visual acuities were always satisfied when the pupil diameter was greater than 2 mm.5

The Lentis Mplus toric LU-313 30TY IOL used in this study provided satisfactory visual performance for all included eyes, which had preoperative pupil diameters of greater than 2 mm. Statistically significant improvements in both distance and near visual acuities were found after implanting this new-generation toric IOL model (P < .05). The UDVA increased eight lines from the baseline (from 20/125 to 20/16), whereas UNVA increased five lines (from 20/125 to 20/32). Additionally, there were statistically significant correlations between preoperative pupil diameters and postoperative near visual acuities under both photopic and mesopic conditions (Rs > 0; P < .05; Table A and Figure 1). This means that those eyes with larger pupil sizes obtained better distance and near vision after the implantation of the Lentis Mplus toric LU-313 30TY IOL.

The current correlations between the pupil diameters and the visual outcomes imply that, apart from the non-toric models,19 the Lentis Mplus toric LU-313 30TY is a pupil-dependent multifocal IOL model. Although smaller pupil sizes generally have several advantages for normal or pseudophakic eyes,20 such as increasing depths of focus21 and decreasing light scatter22 and higher order aberrations,23 the effects of the pupil size in the current study seem to be more complex because of the rotational asymmetric design of this new multifocal toric IOL model. The exact reason is still unclear. We assume that the smaller pupil size may lessen the toric efficacy of the current IOL model in correcting corneal astigmatisms. It was proved that non-toric Lentis Mplus IOL models were pupillary independent.19 The current Lentis Mplus is a toric IOL. Thus, we assume that the toric design affects the relationship between pupil size and visual acuity. When the pupil size is small, the “pupil-exposed” optic zone of this IOL model, especially the near segment, will in turn be small (Figure B, available in the online version of this article). Thus, in this study, most of the correlations between the pupil diameters and visual outcomes were present in the near visual acuities and under photopic conditions.

The relationship between the pupil size and Lentis Mplus toric LU-313 30TY intraocular lens (Oculentis GmbH, Berlin, Germany). The gray disc indicates the pupil area. When the pupil is small, the “pupil-exposed” optic zone of this intraocular lens model, especially the near segment, will eventually be small.

Figure B.

The relationship between the pupil size and Lentis Mplus toric LU-313 30TY intraocular lens (Oculentis GmbH, Berlin, Germany). The gray disc indicates the pupil area. When the pupil is small, the “pupil-exposed” optic zone of this intraocular lens model, especially the near segment, will eventually be small.

Hayashi and Hayashi24 found that pupil size decreased after cataract surgery and then returned to preoperative level by 1 month postoperatively. Strong associations between preoperative and postoperative pupil diameters were also found in this previous study. In our opinion, preoperative pupil diameter is more useful than postoperative pupil diameter when predicting the visual outcomes and choosing the optimum IOL models for patients with cataract. Thus, postoperative pupil size was not measured in our study. However, we still believe that the postoperative pupil size played an important role in near visual outcomes of the eyes with Lentis Mplus toric LU-313 30TY IOLs.

We did not establish a recommended pupil size for excellent visual outcomes in this study. This is because some patients with small pupils obtained satisfactory distance and near visual acuities postoperatively.

Theoretically, IOLs are centered on the geometric center of the cornea (or limbus center), but not on the pupillary axis.25 Thus, pupil decentration would be another important parameter for the visual performance of IOLs.26,27 Interestingly, although the near segment of this IOL model is located at the inferior quadrants, no statistically significant correlations were found between superior (0° to 180°) pupil decentrations and the postoperative visual conditions nor between inferior (180° to 360°) pupil decentrations and the postoperative visual conditions (P > .05; Table C). This may be because the slight pupil decentration in our study (Table 1) could not affect the visual outcomes. Further studies are needed to verify this assumption by including more eyes with the current IOL model.

Lentis Mplus toric LU-313 30TY IOLs provided excellent distance and near visual acuities during our 3-month follow-up. The preoperative pupil size is an important parameter when this new-generation toric multifocal IOL model is contemplated for implantation. Patients with large pupil diameters could get better visual outcomes than those with small pupil diameters. Various further influencing factors (eg, distance and near contrast sensitivities) should be looked into to verify the current hypothesis of pupil influence on the visual performance of this new IOL model in the future.

References

  1. Hoffer KJ. Biometry of 7,500 cataractous eyes. Am J Ophthalmol. 1980;90:360–368. doi:10.1016/S0002-9394(14)74917-7 [CrossRef]
  2. Alió JL, Piñero DP, Plaza-Puche AB, Chan MJ. Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens. J Cataract Refract Surg. 2011;37:241–250. doi:10.1016/j.jcrs.2010.08.043 [CrossRef]
  3. Alió JL, Plaza-Puche AB, Piñero DP, Javaloy J, Ayala MJ. Comparative analysis of the clinical outcomes with 2 multifocal intraocular lens models with rotational asymmetry. J Cataract Refract Surg. 2011;37:1605–1614. doi:10.1016/j.jcrs.2011.03.054 [CrossRef]
  4. Alió JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Vega-Estrada A. Clinical and optical intraocular performance of rotationally asymmetric multifocal IOL plate-haptic design versus C-loop haptic design. J Refract Surg. 2013;29:252–259. doi:10.3928/1081597X-20130318-04 [CrossRef]
  5. McAlinden C, Moore JE. Multifocal intraocular lens with a surface-embedded near section: short-term clinical outcomes. J Cataract Refract Surg. 2011;37:441–445. doi:10.1016/j.jcrs.2010.08.055 [CrossRef]
  6. Montés-Micó R, López-Gil N, Pérez-Vives C, Bonaque S, Ferrer-Blasco T. In vitro optical performance of nonrotational symmetric and refractive-diffractive aspheric multifocal intraocular lenses: impact of tilt and decentration. J Cataract Refract Surg. 2012;38:1657–1663. doi:10.1016/j.jcrs.2012.03.040 [CrossRef]
  7. Muñoz G, Albarrán-Diego C, Javaloy J, Sakla HF, Cerviño A. Combining zonal refractive and diffractive aspheric multifocal intraocular lenses. J Refract Surg. 2012;28:174–181. doi:10.3928/1081597X-20120215-02 [CrossRef]
  8. Khoramnia R, Auffarth GU, Rabsilber TM, Holzer MP. Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments. J Cataract Refract Surg. 2012;38:2049–2052. doi:10.1016/j.jcrs.2012.08.042 [CrossRef]
  9. Venter J, Pelouskova M. Outcomes and complications of a multifocal toric intraocular lens with a surface-embedded near section. J Cataract Refract Surg. 2013;39:859–866. doi:10.1016/j.jcrs.2013.01.033 [CrossRef]
  10. Yuan Y, Shao Y, Tao A, et al. Ocular anterior segment biometry and high-order wavefront aberrations during accommodation. Invest Ophthalmol Vis Sci. 2013;54:7028–7037. doi:10.1167/iovs.13-11893 [CrossRef]
  11. Ruiz-Alcocer J, Madrid-Costa D, García-Lázaro S, Ferrer-Blasco T, Montés-Micó R. Optical performance of two new trifocal intraocular lenses: through-focus modulation transfer function and influence of pupil size. Clin Experiment Ophthalmol. 2014;42:271–276. doi:10.1111/ceo.12181 [CrossRef]
  12. Pepose JS, Wang D, Altmann GE. Comparison of through-focus image sharpness across five presbyopia-correcting intraocular lenses. Am J Ophthalmol. 2012;154:20–28. doi:10.1016/j.ajo.2012.01.013 [CrossRef]
  13. Jun I, Choi YJ, Kim EK, Seo KY, Kim TI. Internal spherical aberration by ray tracing-type aberrometry in multifocal pseudophakic eyes. Eye (Lond). 2012;26:1243–1248. doi:10.1038/eye.2012.129 [CrossRef]
  14. Venter JA, Pelouskova M, Collins BM, Schallhorn SC, Hannan SJ. Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens. J Cataract Refract Surg. 2013;39:1477–1484. doi:10.1016/j.jcrs.2013.03.035 [CrossRef]
  15. van der Linden JW, van Velthoven M, van der Meulen I, Nieuwendaal C, Mourits M, Lapid-Gortzak R. Comparison of a new-generation sectorial addition multifocal intraocular lens and a diffractive apodized multifocal intraocular lens. J Cataract Refract Surg. 2012;38:68–73. doi:10.1016/j.jcrs.2011.06.034 [CrossRef]
  16. Lane SS, Morris M, Nordan L, Packer M, Tarantino N, Wallace RB 3rd, . Multifocal intraocular lenses. Ophthalmol Clin North Am. 2006;19:89–105.
  17. Terwee T, Weeber H, van der Mooren M, Piers P. Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refractive multifocal intraocular lenses. J Refract Surg. 2008;24:223–232.
  18. Alió JL, Plaza-Puche AB, Javaloy J, Ayala MJ. Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL. J Refract Surg. 2012;28:100–105. doi:10.3928/1081597X-20120110-01 [CrossRef]
  19. Muñoz G, Albarrán-Diego C, Ferrer-Blasco T, Sakla HF, García-Lázaro S. Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. J Cataract Refract Surg. 2011;37:2043–2052. doi:10.1016/j.jcrs.2011.05.045 [CrossRef]
  20. Singh A, Pesala V, Garg P, Bharadwaj SR. Relation between uncorrected astigmatism and visual acuity in pseudophakia. Optom Vis Sci. 2013;90:378–384. doi:10.1097/OPX.0b013e318288afb5 [CrossRef]
  21. Kamiya K, Kobashi H, Shimizu K, Kawamorita T, Uozato H. Effect of pupil size on uncorrected visual acuity in astigmatic eyes. Br J Ophthalmol. 2012;96:267–270. doi:10.1136/bjo.2011.202481 [CrossRef]
  22. Schwiegerling J. Theoretical limits to visual performance. Surv Ophthalmol. 2000;45:139–146. doi:10.1016/S0039-6257(00)00145-4 [CrossRef]
  23. Milsom PK, Till SJ, Rowlands G. The effect of ocular aberrations on retinal laser damage thresholds in the human eye. Health Phys. 2006;91:20–28. doi:10.1097/01.HP.0000194203.58594.66 [CrossRef]
  24. Hayashi K, Hayashi H. Pupil size before and after phacoemulsification in nondiabetic and diabetic patients. J Cataract Refract Surg. 2004;30:2543–2550. doi:10.1016/j.jcrs.2004.04.045 [CrossRef]
  25. Barry JC, Backes A. Limbus versus pupil center for ocular alignment measurement with corneal reflexes. Invest Ophthalmol Vis Sci. 1997;38:2597–2607.
  26. Soda M, Yaguchi S. Effect of decentration on the optical performance in multifocal intraocular lenses. Ophthalmologica. 2012;227:197–204. doi:10.1159/000333820 [CrossRef]
  27. Prakash G, Prakash DR, Agarwal A, Kumar DA, Agarwal A, Jacob S. Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation. Eye (Lond). 2011;25:1187–1193. doi:10.1038/eye.2011.150 [CrossRef]

Demographic Data of the Study Population

CharacteristicValue
No. of patients (female/male)24 (10/14)
Mean ± SD age, y61.46 ± 6.40 (range: 47 to 72)
Mean ± SD spherical power of intraocular lenses, D14.40 ± 6.15 (range: 1.65 to 24.70)
Mean ± SD cylindrical power of intraocular lenses, D2.04 ± 0.88 (range: 0.56 to 4.74)
Mean ± SD pupil size under photopic conditions, mm3.57 ± 0.70 (range: 2.56 to 5.92)
Mean ± SD pupil size under mesopic conditions, mm5.12 ± 0.86 (range: 3.64 to 7.40)
Mean ± SD pupil decentration under photopic conditions, mm0.22 ± 0.10 (range: 0.01 to 0.39)
Mean ± SD pupil decentration under mesopic conditions, mm0.24 ± 0.10 (range: 0.02 to 0.41)

Visual and Refractive Outcomes Before and After Multifocal Toric IOL Implantation

ParameterPreoperative3-Month PostoperativeP
UDVA, logMAR (Snellen)0.81 ± 0.56 (20/125)−0.01 ± 0.19a (20/20)< .0001
CDVA, logMAR (Snellen)−0.01 ± 0.13 (20/20)−0.13 ± 0.09a (20/16)< .0001
Sphere, D−2.51 ± 4.930.94 ± 0.52a.0006
Cylinder, D−0.86 ± 0.57−0.69 ± 0.42.5563
MRSE, D−2.94 ± 4.950.55 ± 0.53a.0010
UIVA, logMAR (Snellen)0.61 ± 0.21 (20/80)0.84 ± 0.22a (20/125).0125
UNVA, logMAR (Snellen)0.80 ± 0.44 (20/125)0.23 ± 0.21a (20/32)< .0001
CNVA, logMAR (Snellen)0.06 ± 0.11 (20/25)0.04 ± 0.09 (20/20).8425
ADD, D+2.24 ± 0.69+0.38 ± 0.46a< .0001

Correlation Between Preoperative Pupil Diameters and 3-Month Postoperative Visual Outcomes

Pupil DiameterRsP
Photopic (n = 27 eyes)
  UDVA0.4346.0235a
  CDVA0.2606.1892
  UIVA0.3887.0548
  UNVA0.4309.0280a
  CNVA0.5064.0083a
Mesopic (n = 27 eyes)
  UDVA0.3791.0511
  CDVA0.1518.4497
  UIVA0.2961.1507
  UNVA0.3535.0764
  CNVA0.4407.0242a

Correlation Between Preoperative Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Pupil DecentrationRsP
Photopic (n = 27 eyes)
  UDVA0.0184.9274
  CDVA0.0666.7412
  UIVA0.0248.9062
  UNVA0.0964.6396
  CNVA0.0057.9779
Mesopic (n = 27 eyes)
  UDVA0.1193.5533
  CDVA0.1220.5443
  UIVA0.2830.1704
  UNVA0.3561.0741
  CNVA0.4512.0207a

Correlation Between Superior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Pupil DecentrationRsP
Photopic (n = 9 eyes)
  UDVA0.5256.1461
  CDVANANA
  UIVA0.1594.6821
  UNVA0.1695.6628
  CNVA0.2070.5930
Mesopic (n = 8 eyes)
  UDVA0.0257.9518
  CDVANANA
  UIVA0.6736.0671
  UNVA0.3437.4045
  CNVA0.5040.2029

Correlation Between Inferior Pupil Decentrations and 3-Month Postoperative Visual Outcomes

Pupil DecentrationRsP
Photopic (n = 17 eyes)
  UDVA0.1052.6878
  CDVA0.0610.8160
  UIVA0.0382.8926
  UNVA0.0965.7222
  CNVA0.1407.6033
Mesopic (n = 18 eyes)
  UDVA0.0572.8217
  CDVA0.0119.9625
  UIVA0.3317.1934
  UNVA0.4600.0632
  CNVA0.0655.8095
Authors

From Shinagawa LASIK Center, Tokyo, Japan (MW, CCCC, TH, MT); and the Department of Ophthalmology, Wenzhou Medical College, Wenzhou, People's Republic of China (MT).

Dr. Tomita is a consultant for VSY Biotechnology Inc. The remaining authors have no financial or proprietary interest in the materials presented herein.

AUTHOR CONTRIBUTIONS

Study concept and design (MW, CCCC, MT); analysis and interpretation of data (MW, TH); writing the manuscript (MW); critical revision of the manuscript (CCCC, TH, MT); statistical expertise (MW, CCCC, TH, MT); administrative, technical, or material support (MW, TH, MT); supervision (MT)

Correspondence: Minoru Tomita, MD, PhD, Shinagawa LASIK Center, ITOCiA 14F, 2-7-1 Yurakucho, Chiyoda-ku, Tokyo, 100-0006, Japan. E-mail: harvard-medical1972@gmail.com

Received: March 30, 2014
Accepted: November 24, 2015

10.3928/1081597X-20160105-01

Sign up to receive

Journal E-contents